Anthracycline- and trastuzumab-induced cardiotoxicity: a retrospective study

Area of Science:

• Cardiology
• Oncology
• Pharmacology

Background:

• Chemotherapeutic agents, including anthracyclines and HER2 monoclonal antibodies, can induce cardiotoxicity.
• Clinical data on left ventricular ejection fraction (LVEF) changes, risk factors, and acute recovery from these therapies is limited.

Purpose of the Study:

• To retrospectively analyze LVEF changes in cancer patients receiving anthracyclines and/or trastuzumab.
• To identify risk factors associated with LVEF decline and evaluate the rate of acute LVEF recovery.

Main Methods:

• Retrospective review of electronic medical records from 2000-2013 at an academic medical center.
• Collected patient characteristics and serial LVEF assessments for patients receiving anthracyclines and/or trastuzumab.
• Analyzed patients with and without LVEF decline using univariate and multivariate analyses.

Main Results:

• A significant LVEF fall occurred in 12.5% of patients with multiple LVEF assessments; symptomatic congestive heart failure (CHF) was rare (0.5%).
• Hypertension, hyperlipidemia, and coronary artery disease (CAD) were associated with LVEF decline.
• Concomitant trastuzumab and anthracycline use was a significant risk factor (36% vs 9.5% for anthracycline alone).
• Hypertension and trastuzumab use were independent predictors of LVEF fall on multivariate analysis.
• Acute LVEF recovery was observed in 44% of patients.

Conclusions:

• LVEF changes due to cancer therapies are common but difficult to predict.
• Pre-existing conditions like hypertension, hyperlipidemia, and CAD increase the risk of LVEF decline.
• Prompt interruption of cardiotoxic chemotherapy is recommended, as acute LVEF recovery is achievable.